Norovirus and Rotavirus Prevalence in Immunocompromised Patients and Nosocomial Infections in Egleston and Scottish Rite Children's Hospitals in Atlanta, GA 公开

Munir, Naeemah Aneesa (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/bv73c0623?locale=zh
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Abstract

Background: The introduction of the rotavirus vaccine in 2006 has decreased acute gastroenteritis (AGE) cases among children. The relative contribution of norovirus infections after the vaccine implementation has not been well described, particularly in immunocompromised patients and nosocomial AGE infections. Furthermore, immunocompromised patients may be a source of nosocomial infections due to these patients' lengthy hospital stays, prolonged viral shedding, and low infectious dose and environmental persistence of norovirus.

Methods: Stool specimens were collected between December 2009 and December 2010 from two children's hospitals: Egleston and Scottish Rite, in Atlanta, Georgia. We reviewed patients' electronic medical records for inclusion criteria of diarrhea, immunocompromised status, and/or nosocomial status. Our inclusion criterion for diarrhea was defined as ≥3 watery or looser-than-normal stools within a 24-hour period, or forceful vomiting with any loose stools. Immunocompromised patients were defined as having cancer, neutropenia, or transplant. Nosocomial cases were defined as diarrheal onset at least 48 hours after hospital admissions. Norovirus and rotavirus were tested in stool samples using RT-PCR and ELISA, respectively.

Results: A total of 111 patients were consisted in this study, with 59 (53.2%) immunocompromised, 31 (27.9%) nosocomial cases, and 21 (18%) both immunocompromised and nosocomial cases. We detected norovirus infections in 18 (16.2%) and rotavirus infections in 2 (1.8%) patients. All norovirus infections were GII, with 10 (55.6%) being GII.4 strain. Norovirus infections occurred between December and April. Among the enrolled patients, 20% received the rotavirus vaccine and 65% were born before the vaccine introduction, and were thus ineligible for rotavirus vaccination. There were no significant differences regarding the clinical symptoms between norovirus positive AGE and norovirus negative AGE. When analyzing the transmission source of norovirus nosocomial infection, there were no immunocompromised norovirus infections that preceded nosocomial cases, suggesting that immunocompromised norovirus infections are not the source of nosocomial norovirus infections.

Conclusion: Norovirus was the most prevalent etiology in immunocompromised AGE patients and nosocomial AGE infections in two pediatric hospitals in Atlanta. Our findings provide supporting evidence for a norovirus vaccine, development of a rapid norovirus assay, and enforcement of stricter appropriate hygiene policies to decrease nosocomial infections.

Table of Contents

Introduction…………………………………………………………. 1
Methods…………………………………………………………….... 5
Results……………………………………………………………….. 10
Discussion………………………………………………………….. 14
Conclusion………………………………………………………….. 22
References…………………………………………………………. 23
Tables & Figures…………………………………………………..30
Appendix………………………………………………………….... 39

Background………………………………………………......... 39
Clinical Abstraction Form………………………………….. 54

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